Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting

Shanewise, Jack S.; Kosinski, Andrzej S.; Coto, Jorge A.; Jones, Ellis L.

doi:10.1016/s0022-5223(98)70417-9

Cited by 12 publications

(4 citation statements)

References 10 publications

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“…Mild systemic cooling and the administration of heparin, both of which decrease complement activation [44,45], the utilization of bloodbased cardioplegic solutions [82,123,124], magnesium supplementation [93] and moderate calcium depletion [15] of cardioplegic solutions all have beneficial effects on endothelium-dependent relaxation, myogenic contraction, responses to adrenergic agonists, and other indices of myocardial vascular health after CPB and ischemiareperfusion. It should be remembered, however, that several of these strategies may prove beneficial for emergency or high-risk patients only, as improved outcomes related to their use during routine operations has not been demonstrated [125,126].…”

Section: Discussionmentioning

confidence: 99%

Vasomotor dysfunction after cardiac surgery

Ruel

Khan

Voisine

et al. 2004

European Journal of Cardio-Thoracic Surgery

106

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Cardiopulmonary bypass and cardioplegic arrest, which allow for support of the circulation and stabilization of the heart during cardiac procedures, are still used for the vast majority of cardiac operations worldwide. However, in addition to a well-recognized systemic inflammatory response, cardiopulmonary bypass and cardioplegic arrest elicit complex, multifactorial vasomotor disturbances that vary according to the affected organ bed, with reduced vascular resistances in the skeletal muscle and peripheral circulation, and increased propensity to spasm in the cardiac, pulmonary, mesenteric and cerebral vascular beds. This article outlines the nature, mechanistic basis, and clinical correlates of the vasomotor alterations encountered in patients undergoing cardiac surgery using cardiopulmonary bypass and cardioplegic arrest.

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Section: Discussionmentioning

confidence: 99%

Vasomotor dysfunction after cardiac surgery

Ruel

Khan

Voisine

et al. 2004

European Journal of Cardio-Thoracic Surgery

106

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“…However, a clinical benefit of blood cardioplegia or of the addition of metabolic enhancers to a cardioplegic solution has been difficult to demonstrate under non-ischemic conditions (54,55). The mechanism of the positive effect of blood is uncertain but may be due to its potent inhibitory effects on oxygen-derived free radical generation, improved oxygenation of tissues (thereby decreasing the amount of vascular ischemia), buffering capacity of histidine and other blood proteins or preservation of morphological integrity of the endothelium (6,8).…”

Section: Prevention Of Microvascular Injurymentioning

confidence: 99%

Vascular changes after cardiopulmonary bypass and ischemic cardiac arrest: roles of nitric oxide synthase and cyclooxygenase

Sellke

1999

Braz J Med Biol Res

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Cardiac surgery involving ischemic arrest and extracorporeal circulation is often associated with alterations in vascular reactivity and permeability due to changes in the expression and activity of isoforms of nitric oxide synthase and cyclooxygenase. These inflammatory changes may manifest as systemic hypotension, coronary spasm or contraction, myocardial failure, and dysfunction of the lungs, gut, brain and other organs. In addition, endothelial dysfunction may increase the occurrence of late cardiac events such as graft thrombosis and myocardial infarction. These vascular changes may lead to increased mortality and morbidity and markedly lengthen the time of hospitalization and cost of cardiac surgery. Developing a better understanding of the vascular changes operating through nitric oxide synthase and cyclooxygenase may improve the care and help decrease the cost of cardiovascular operations. Correspondence

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“…Surprisingly, new wall motion abnormalities have been detected during CABG with TEE more frequently after surgery with CPB than before. 33,39 Also, RWMAs appearing after CPB have been related to adverse outcomes. 33 On emergence from CPB, 10% to 15% of CABG patients have a new RWMA not present at baseline, an occurrence that should be the cause of considerable concern, warranting immediate discussion with the surgeon.…”

Section: Implications Of Rwmas During Cabgmentioning

confidence: 99%

How to Reliably Detect Ischemia in the Intensive Care Unit and Operating Room

Shanewise

2006

Semin Cardiothorac Vasc Anesth

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Detection of myocardial ischemia in the perioperative period is important because it allows for intervention that may prevent progression of ischemia to myocardial infarction. Perioperative ischemia is also an important predictor of adverse cardiovascular outcomes. Patients should first be stratified according to their risk of having cardiovascular disease by identifying major, intermediate, and minor predictors of adverse cardiovascular outcome. Electrocardiographic (ECG) monitoring for ischemia is inexpensive and noninvasive, but may not be applicable to all patients and is not perfectly sensitive or specific. Modern operating room monitors can automate ST segment monitoring and be set to alarm if changes occur. Increases in central venous pressure and pulmonary artery pressure can be caused by myocardial ischemia, but have been shown to be very insensitive compared to ECG. Also, detection of these hemodynamic changes requires insertion of invasive monitoring devices. Transesophageal echocardiography can be used to detect myocardial ischemia by identifying changes in regional wall motion. These transesophageal echocardiography changes occur sooner and more frequently than ECG changes, but require greater knowledge and skill to properly interpret.

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Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting

Abstract: This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting.

Cited by 12 publications

References 10 publications

Vasomotor dysfunction after cardiac surgery

Vasomotor dysfunction after cardiac surgery

Vascular changes after cardiopulmonary bypass and ischemic cardiac arrest: roles of nitric oxide synthase and cyclooxygenase

How to Reliably Detect Ischemia in the Intensive Care Unit and Operating Room

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